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Abstract

Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)þMemory Support (n ¼ 25) or CT-as-usual (n ¼ 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CTþMemory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for ‘response’ and ‘remission’ were higher in CTþMemory Support compared with CT-as-usual. CTþMemory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CTþMemory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome.

3. Discussion

Before highlighting the main results, it might be helpful to reemphasize that following the tradition of pilot RCTs this study was not powered to obtain significant effects (Lee et al., 2014). The findings confirm that the Memory Support Intervention can reliably manipulate memory support. Indeed, the total amount of memory support used and number of types of memory support were significantly higher in the CTþMemory Support group compared to the CT-as-usual group and the effect sizes were large. The average dose of memory support in a trial-quality standard 50- min CT session was 8e9 units, relative to an average dose of 18e19 units when the Memory Support Intervention is added. An inspection of the mean values provides some encouragement that patients who receive memory support recall more treatment points at posttreatment compared with those who do not receive memory support. The Cohen's d effect size group difference was in the small to medium range, although the difference did not reach statistical significance. Taken together, these findings are consistent with prior demonstrations that memory support can improve recall (Almkvist et al., 2010; Bamidis et al., 2014; Bunce, 2003). At 6- month follow-up, although the mean values are in the predicted direction, there was a notable drop-off in patient memory for treatment compared with the posttreatment assessment. Perhaps booster memory support is needed to ensure that gains are maintained.